Key result
3D computational models fail to predict acute post-TMVR LVOT obstruction due to anterior leaflet displacement.
Why the study?
Current 3D computational models predict neo-LVOT and LVOTO risk after TMVR, but do not account for the interaction between the anterior mitral valve leaflet and the transcatheter heart valve.
Current 3D computational models for TMVR planning may fail to predict LVOT obstruction because they do not account for anterior mitral valve leaflet displacement.
Exercise caution despite reassuring 3D neo-LVOT models before TMVR; challenges their predictive accuracy and leaves open need for dynamic leaflet simulation.
Transcatheter mitral valve replacement (TMVR) is a less invasive alternative for patients with mitral valve disease who are at high surgical risk. TMVR demonstrates favorable outcomes, however left ventricular outflow tract obstruction (LVOTO) remains a notorious, potentially life-threatening complication. Three-dimensional computational models (3DCMs) have been developed to simulate the residual neo-LVOT and assess the risk of LVOTO. However, they do not account for the interaction between the anterior mitral valve leaflet (AMVL) and the transcatheter heart valve. We present the case of an 81-year-old female who had reassuring pre-procedural neo-LVOT assessment but experienced acute LVOTO due to AMVL displacement following TMVR. This case emphasizes the strengths and limitations of current 3DCMs in accurately predicting LVOT obstruction. Furthermore, we discuss techniques to prevent and manage LVOT obstruction after TMVR. • 3D computational modeling tools do not model AMVL–THV interactions after TMVR. • LVOT obstruction can occur despite reassuring pre-procedural neo-LVOT sizing. • Surgical resection of the anterior mitral leaflet is one method to resolve LVOTO.
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Assis et al. (2026) studied this question. 3D computational models fail to predict acute LVOT obstruction post-TMVR due to anterior mitral leaflet displacement despite reassuring pre-procedural neo-LVOT sizing.
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